Whistleblowers Accuse Adventist Health System of Overbilling US Government Tens of Millions of Dollars in False Medicaid and Medicare Claims

Posted By
The Gilbert Law Group

Two people have filed a whistleblower lawsuit accusing Adventist Health
System of submitting false claims worth tens of millions of dollars and
defrauding the federal government. According to bill-coding and reimbursement
compliance officer Amanda Dittman and radiologist Charlotte Elenberger,
who were either affiliated with or employed with the hospital system between
1995 and 2009, seven hospitals were involved in the Tricare/Medicare/Medicaid
fraud, which allegedly went on for years. Several months ago, four Adventist
Health hospitals paid the US government $3.9 million to settle Medicaid
fraud allegations.
The whistleblowers contend that Adventist Health System applied improper
coding to overbill Tricare, Medicaid, and Medicare. According to Dittman,
who worked for Florida Radiology Associates, and later with Florida Hospital
Orlando, and was in charge of billing responsibilities related to the
hospitals’ radiology departments, she saw billing-code modifiers
regularly misused so as to render “extra payments.” She also
claims that it wasn’t unusual to use a billing code to claim payment
for a bigger dose of octreotide than what was really administered. (Dittman
contends that instead of billing for 1,000 micrograms of the drug, which
is used to generate better radiology images, the government was overcharged
by about $2,500/dose.) She also claims that Florida Hospital Orlando billed
for CAD analysis, which is supposed to help doctors better understand
mammography scans, even when this analysis wasn’t used.
Now, two years after Dittman and Elenberger filed their whistleblower
lawsuit, U.S. District Judge John Antoon has denied the defendant’s
motion to dismiss the Florida whistleblower complaint and says that the
lawsuit can proceed. Although Adventist Health had asked for the case
to be dismissed due to not enough evidence, Antoon said that the lawsuit
fulfills the requirements of the False Claims Act as they relate to fraud
allegations.
The plaintiffs’ whistleblower lawyer believes that if found guilty,
the health system’s total exposure could go above $100 million.
One reason for this is not only would the
defendant have to pay back the excess money it had obtained from the government,
but also, there would likely be civil penalties of $5,500 to $11,000/per
false claim.
A guilty verdict for the defendants would likely entitle both whistleblowers
to a percentage of what the government requires. This is one of the benefits
of filing a whistleblower lawsuit to expose fraud against the government.
Not only that, but your case could create a dent in the estimated billions
of dollars in fraud against the government that is committed every year.
According to the Centers for Medicare and Medicaid, 3-10% of the $2.6
trillion in yearly healthcare expenditures in 2010 may have come from
fraudulent claims.
The False Claims Act lets citizens blow the whistle by filing a Qui Tam
complaint. You should know that as a whistleblower, you have certain rights,
including protection from harassment and wrongful termination. You want
to work with a whistleblower law firm that can protect you, help you file
a successful lawsuit, and make sure you get the recovery that you are owed.